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Sileo KM, Muhumuza C, Wanyenze RK, Kershaw TS, Ellerbe B, Muñoz S, Sekamatte S, Lule H, Kiene SM. Effects of a community-based, multi-level family planning intervention on theoretically grounded intermediate outcomes for couples in rural Uganda: Results from a mixed methods pilot evaluation. Br J Health Psychol 2024. [PMID: 38242837 DOI: 10.1111/bjhp.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES This study tested the theoretically grounded conceptual model of a multi-level intervention, Family Health = Family Wealth (FH = FW), by examining FH = FW's effect on intermediate outcomes among couples in rural Uganda. FH = FW is grounded in the social-ecological model and the social psychological theory of transformative communication. DESIGN A pilot quasi-experimental controlled trial. METHODS Two matched clusters (communities) were randomly allocated to receive the FH = FW intervention or an attention/time-matched water, sanitation and hygiene intervention (N = 140, 35 couples per arm). Quantitative outcomes were collected through interviewer-administered questionnaires at baseline, 7-months and 10-months follow-up. Focus group discussions (n = 39) and semi-structured interviews (n = 27) were conducted with subsets of FH = FW participants after data collection. Generalized estimated equations tested intervention effects on quantitative outcomes, and qualitative data were analysed through thematic analysis-these data were mixed and are presented by level of the social-ecological model. RESULTS The findings demonstrated an intervention effect on family planning determinants across social-ecological levels. Improved individual-level family planning knowledge, attitudes and intentions, and reduced inequitable gender attitudes, were observed in intervention versus comparator, corroborated by the qualitative findings. Interpersonal-level changes included improved communication, shared decision-making and equitable relationship dynamics. At the community level, FH = FW increased perceived acceptance of family planning among others (norms), and the qualitative findings highlighted how FH = FW's transformative communication approach reshaped definitions of a successful family to better align with family planning. CONCLUSIONS This mixed methods pilot evaluation supports FH = FW's theoretically grounded conceptual model and ability to affect multi-level drivers of a high unmet need for family planning.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Christine Muhumuza
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavior Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brooke Ellerbe
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Suyapa Muñoz
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | | | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Susan M Kiene
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University (SDSU) School of Public Health, San Diego, California, USA
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Muhumuza C, Sileo KM, Wanyenze RK, Kershaw TS, Lule H, Sekamatte S, Kiene SM. Development of a multi-level family planning intervention for couples in rural Uganda: key findings & adaptations made from community engaged research methods. BMC Womens Health 2023; 23:545. [PMID: 37865746 PMCID: PMC10590522 DOI: 10.1186/s12905-023-02667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/21/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Uganda has among the highest fertility rates in the world and multi-level barriers contribute to the low contraceptive use. OBJECTIVE The objective of this study was to develop a culturally and socially relevant, community-based intervention to increase contraceptive use among couples in rural Uganda through community-engaged research methods. This study reports on the community-engaged research that informed the intervention's content and structure and the final content of the intervention; the evaluation of the pilot intervention will be reported upon completion. METHODS An intervention steering committee of community stakeholders reviewed the initially proposed intervention content and approach. Four (4) gender-segregated focus groups were conducted with twenty-six (26) men and women who had an unmet need for family planning. Fifteen key-informant interviews were conducted with community leaders and family planning stakeholders. Finally, the 4-session intervention was pilot tested with a cohort of couples (N = 7) similar in demographics to the target sample of the future pilot intervention trial. Qualitative data were analyzed thematically. RESULTS Findings included the identification of community beliefs to reshape in order to increase family planning acceptance, as well as strategies to engage men, acceptable approaches for community leader involvement in the intervention to endorse family planning, and methods for managing gender dynamics and minimizing risk of unintended negative consequences of participation. The findings were used to inform the ideal structure and format of the intervention, including the distribution of contraceptives directly during group sessions, and identified the need to strengthen health worker capacity to provide Long-Acting Reversable Contraceptives (LARCs) as part of the intervention. CONCLUSIONS These findings were used to refine an intervention before a larger scale pilot test of its feasibility, acceptability, and potential efficacy. They can inform other multi-level family planning interventions in similar settings and the methods can be adopted by others to increase the feasibility, acceptability, and cultural relevance of interventions.
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Affiliation(s)
- Christine Muhumuza
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
| | - Katelyn M Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Haruna Lule
- Gombe Hospital, Butambala Local Government, Kayenje, Uganda
| | | | - Susan M Kiene
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
- School of Public Health, San Diego State University, San Diego, USA
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Willie TC, Alexander KA, Sharpless L, Zemlak JL, Smith MV, Kershaw TS. Recent Economic Intimate Partner Violence and Posttraumatic Stress Symptoms Among a Racially and Ethnically Diverse Sample of U.S. Women Experiencing Intimate Partner Violence. J Interpers Violence 2023; 38:11091-11116. [PMID: 37387530 DOI: 10.1177/08862605231178357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent consequence of physical and sexual intimate partner violence (IPV); however, little is known about the unique contributions of economic IPV. Furthermore, women's economic self-sufficiency may explicate the potential relationship between economic IPV and PTSD symptoms. Guided by the Stress Process Theory and Intersectionality, this study examined associations between economic IPV and women's PTSD symptoms and assessed economic self-sufficiency as a mediator. Participants were 255 adult women experiencing IPV recruited from metropolitan Baltimore, MD, and the state of CT who participated in two different studies. Participants completed surveys on IPV, economic self-sufficiency, and PTSD. Path analyses were conducted to examine direct and indirect associations of economic IPV with economic self-sufficiency and PTSD. Economic IPV was uniquely associated with PTSD symptoms while controlling for other forms of IPV. Economic self-sufficiency significantly partially mediated the association between economic IPV and PTSD symptoms such that economic IPV was associated with PTSD symptoms through economic self-sufficiency. Economic IPV may limit women's ability to make autonomous decisions related to finances, which could be distressing. The mental health impact of economic IPV may be particularly debilitating for women with low economic self-sufficiency as their posttraumatic stress occurs within the context of feeling unable to meet their financial goals and also having a partner control their economic resources. Fostering economic empowerment and asset building may be a strengths-based approach to reduce the PTSD symptomatology among women experiencing IPV.
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Affiliation(s)
- Tiara C Willie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Megan V Smith
- Yale School of Public Health, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
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Sileo KM, Muhumuza C, Wanyenze RK, Kershaw TS, Sekamatte S, Lule H, Kiene SM. A pilot quasi-experimental controlled trial of a community-based, multilevel family planning intervention for couples in rural Uganda: evidence of feasibility, acceptability, and effect on contraceptive uptake among those with an unmet need for family planning. Contraception 2023; 125:110096. [PMID: 37355086 PMCID: PMC10966983 DOI: 10.1016/j.contraception.2023.110096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Effective interventions to reduce the unmet need for family planning in low-income settings are limited. This study aimed to establish the feasibility, acceptability, and preliminary effects of Family Health=Family Wealth (FH=FW), a multilevel intervention aimed to increase high-efficacy contraceptive uptake among couples wanting to delay pregnancy. STUDY DESIGN A pilot quasi-experimental controlled trial was conducted in rural Uganda, with 70 couples wanting to delay pregnancy but not using contraceptives (n = 140). Two matched clusters (communities) were randomly allocated to receive FH=FW or a comparator intervention via coin toss. FH=FW included health system strengthening elements and four facilitated group sessions. Interviewer-administered questionnaires were conducted at baseline and at ∼7-month and ∼10-month follow-up, and process data gathered feasibility/acceptability outcomes. RESULTS Of 121 households visited in the intervention community, 63 couples were screened, and 35 enrolled. In the comparator, 61 households were visited, 45 couples screened, and 35 enrolled. Intervention attendance was 99%, fidelity was 96%, and 100% of participants reported being satisfied with the intervention. From no use at baseline, there was 31% more high efficacy contraceptive uptake at 7 months and 40% more at 10 months in intervention versus comparator couples (adjusted odds ratio = 1.68, 95% confidence interval = 0.78-3.62, p = 0.19). A decline in fertility desires was observed in intervention versus comparator participants from baseline (Wald χ2 = 9.87, p = 0.007; Cohen's d: 7 months, 0.06; 10 months, 0.49). CONCLUSIONS FH=FW is a feasible and acceptable intervention with strong promise in its effect on contraceptive uptake to be established in a future trial. IMPLICATIONS The FH=FW intervention addresses multilevel family planning barriers through four group dialogs with couples paired with efforts to reduce health system barriers. A quasi-experimental controlled trial provides preliminary support for its feasibility, acceptability, contraceptive uptake and fertility desire effects, and success in engaging both women and men.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, United States.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Mulago Kampala, Uganda.
| | - Trace S Kershaw
- Department of Social and Behavior Science, Yale School of Public Health, New Haven, CT, United States.
| | | | - Haruna Lule
- Global Center of Health Excellency (GloCHE), Kampala, Uganda.
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Mulago Kampala, Uganda; Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, United States.
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Wilbourn B, Ogburn DF, Safon CB, Galvao RW, Kershaw TS, Willie TC, Taggart T, Caldwell A, Kaplan C, Phillips N, Calabrese SK. Preexposure Prophylaxis Implementation in a Reproductive Health Setting: Perspectives From Planned Parenthood Providers and Leaders. Health Promot Pract 2023; 24:764-775. [PMID: 35414273 PMCID: PMC9589894 DOI: 10.1177/15248399221086616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Integrating pregnancy and HIV prevention services would make reproductive health care settings an optimal venue for the promotion and delivery of preexposure prophylaxis (PrEP) to cisgender women. However, these settings have been slow to adopt PrEP. Planned parenthood clinicians and leaders possess critical insight that can help accelerate PrEP implementation in reproductive health care settings and elements of the Consolidated Framework for Implementation Research (i.e., relative priority of the intervention to staff, implementation climate, available resources to implement the intervention, and staff access to knowledge and information about the intervention) can shed light on elements of Planned Parenthood's inner setting that can facilitate PrEP implementation. In this study, individual 60-min interviews were conducted with clinical care team members (n = 10), leadership team members (n = 6), and center managers (n = 2) to explore their perspectives on PrEP implementation and associated training needs. Transcripts were transcribed verbatim and thematically analyzed. Despite having variable PrEP knowledge, participants (100% women, 61% non-Hispanic White) expressed positive attitudes toward implementing PrEP. Barriers and facilitators toward providing PrEP were reported at the structural, provider, and patient levels. Participants desired PrEP training that incorporated culturally competent patient-provider communication. Although participants identified ways that Planned Parenthood uniquely enabled PrEP implementation, barriers must be overcome to optimize promotion and delivery of PrEP to cisgender women.
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Affiliation(s)
- Brittany Wilbourn
- Graduate, Translational Health Sciences Program, School of Medicine and Health Sciences, George Washington University, Washington, DC
- Senior Research Associate, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Damon F. Ogburn
- Epidemiologist, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Cara B. Safon
- Research Project Manager, Department of Pediatrics, Boston Medical Center, Boston, MA
| | - Rachel W. Galvao
- Student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Trace S. Kershaw
- Chair and Professor, Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Tiara C. Willie
- Assistant Professor, Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD
| | - Tamara Taggart
- Assistant Professor, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Abigail Caldwell
- Nurse Practitioner; Director of Clinical Research; Director of Primary Care Services, Planned Parenthood of Southern New England, New Haven, CT
| | - Clair Kaplan
- Nurse Practitioner; Director of Clinical Research; Director of Primary Care Services, Planned Parenthood of Southern New England, New Haven, CT
| | - Nicole Phillips
- Nurse Practitioner; Director of Clinical Research; Director of Primary Care Services, Planned Parenthood of Southern New England, New Haven, CT
| | - Sarah K. Calabrese
- Assistant Professor, Department of Psychological and Brain Sciences, George Washington University, Washington, DC
- Assistant Professor, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
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Viera A, Tengatenga C, McBurney E, Lauckner J, Tran E, Muilenburg JL, Kershaw TS, Lauckner C. "The Phone is my Lifeline": Use of Mobile Phone Technology to Support Recovery among Individuals in Treatment for Substance Use Disorders. Subst Use Misuse 2023; 58:1360-1366. [PMID: 37331982 DOI: 10.1080/10826084.2023.2223265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background: People experiencing substance use disorders (SUD) face myriad challenges in maintaining changes in substance use after treatment. Mobile phones can play a role in supporting the recovery process. To date, research has not explored how individuals use mobile phones to seek social support as they enter SUD recovery. Objectives: We sought to understand how individuals in SUD treatment use mobile technology in support of their recovery. Methods: We conducted semi-structured interviews with thirty individuals in treatment for any SUD in northeastern Georgia and southcentral Connecticut. Interviews explored participants' attitudes toward mobile technology and how they used mobile technology while using substances, in treatment, and in recovery. Qualitative data were coded and analyzed using thematic analysis. Results: We identified three major themes related to how participants: (1) adapted their use of mobile technology as they entered recovery, (2) relied on mobile technology for social support while in recovery, while (3) some found aspects of mobile technology triggering. Many individuals in SUD treatment reported using mobile phones to buy or sell drugs; as such, they took measures to adapt their use of mobile technology as they changed substance use behaviors. As they entered recovery, individuals relied on mobile phones for affiliational, emotional, informational, and instrumental support, though some did share they found some aspects of mobile phones triggering. Conclusion: These findings highlight the importance of treatment providers engaging in conversations around mobile phone use to help individuals avoid triggers and connect with social supports. These findings uncover new opportunities for recovery support interventions utilizing mobile phones as a delivery mechanism.
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Affiliation(s)
- A Viera
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - C Tengatenga
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - E McBurney
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - J Lauckner
- Substance Use Research Priority Area, University of Kentucky, Lexington, Kentucky, USA
| | - E Tran
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - J L Muilenburg
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, Athens, Georgia, USA
| | - T S Kershaw
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - C Lauckner
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Sileo KM, Muhumuza C, Helal T, Olfers A, Lule H, Sekamatte S, Kershaw TS, Wanyenze RK, Kiene SM. Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown. Reprod Health 2023; 20:31. [PMID: 36759838 PMCID: PMC9910252 DOI: 10.1186/s12978-023-01566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen's Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19. METHODS Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis. RESULTS We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women's ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns. CONCLUSIONS This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women's autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization.
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Affiliation(s)
- Katelyn M. Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | | | - Teddy Helal
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | - Allison Olfers
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
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Mehra R, Alspaugh A, Dunn JT, Franck LS, McLemore MR, Keene DE, Kershaw TS, Ickovics JR. "'Oh gosh, why go?' cause they are going to look at me and not hire": intersectional experiences of black women navigating employment during pregnancy and parenting. BMC Pregnancy Childbirth 2023; 23:17. [PMID: 36627577 PMCID: PMC9830615 DOI: 10.1186/s12884-022-05268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Workplace legal protections are important for perinatal health outcomes. Black birthing people are disproportionally affected by pregnancy discrimination and bias in the employment context and lack of family-friendly workplace policies, which may hinder their participation in the labor force and lead to gender and racial inequities in income and health. We aimed to explore Black pregnant women's experiences of pregnancy discrimination and bias when looking for work, working while pregnant, and returning to work postpartum. Additionally, we explored Black pregnant women's perspectives on how these experiences may influence their health. METHODS Using an intersectional framework, where oppression is based on intersecting social identities such as race, gender, pregnancy, and socioeconomic status, we conducted an analysis of qualitative data collected for a study exploring the lived experience of pregnancy among Black pregnant women in New Haven, Connecticut, United States. Twenty-four women participated in semi-structured interviews (January 2017-August 2018). Interview transcripts were analyzed using grounded theory techniques. RESULTS Participants expressed their desire to provide a financially secure future for their family. However, many described how pregnancy discrimination and bias made it difficult to find or keep a job during pregnancy. The following three themes were identified: 1) "You're a liability"; difficulty seeking employment during pregnancy; 2) "This is not working"; experiences on the job and navigating leave and accommodations while pregnant and parenting; and 3) "It's really depressing. I wanna work"; the stressors of experiencing pregnancy discrimination and bias. CONCLUSION Black pregnant women in this study anticipated and experienced pregnancy discrimination and bias, which influenced financial burden and stress. We used an intersectional framework in this study which allowed us to more fully examine how racism and economic marginalization contribute to the lived experience of Black birthing people. Promoting health equity and gender parity means addressing pregnancy discrimination and bias and the lack of family-friendly workplace policies and the harm they cause to individuals, families, and communities, particularly those of color, throughout the United States.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA.
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
| | - Amy Alspaugh
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA.
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd, Knoxville, 37916, USA.
| | - Jennifer T Dunn
- Department of Social and Behavioral Sciences, School of Nursing, University of California, 490 Illinois Street, CA, San Francisco, 94158, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Monica R McLemore
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, UCSF Box 0606, CA, 94143, San Francisco, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, CT, 06520, New Haven, USA
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Sileo KM, Muhumuza C, Sekamatte S, Lule H, Wanyenze RK, Kershaw TS, Kiene SM. The "Family Health = Family Wealth" intervention: study protocol for a pilot quasi-experimental controlled trial of a multi-level, community-based family planning intervention for couples in rural Uganda. Pilot Feasibility Stud 2022; 8:265. [PMID: 36564852 PMCID: PMC9789630 DOI: 10.1186/s40814-022-01226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Uganda has one of the highest fertility rates globally, but only 30% of women report using an effective method of contraception. Community-based, multi-level interventions are needed to help couples in rural Uganda overcome barriers to contraceptive use. METHODS This study will pilot test the Family Health = Family Wealth intervention, a multi-level, community-based intervention employing transformative community dialogues, which use facilitated discussion to reshape community norms that influence family planning acceptance, to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4 sessions (two gender-segregated and two gender-mixed). Sessions simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. At the health system level, a refresher training will be conducted with health workers in the intervention community's health center to address gaps in contraceptive knowledge and skills as identified from a needs assessment. The intervention will be evaluated through a pilot quasi-experimental trial paired with a mixed methods process evaluation. Participants include 70 couples (N=140) randomized by community to the Family Health = Family Wealth intervention (n=35 couples) or to an attention-matched water, sanitation, and hygiene (WASH) intervention (n=35 couples). Participants include sexually active, married couples who are age 18 (or an emancipated minor) to 40 for women and age 18 (or an emancipated minor) to 50 for men, not pregnant, at least one person in the couple reports wanting to avoid pregnancy for at least a year, and not currently using a method of contraception or using a low-efficacy or ineffective method of contraception. The primary aims of the study are to (1) assess the feasibility of the intervention trial procedures, (2) the acceptability and feasibility of the intervention content and structure, and (3) explore the intervention's preliminary effectiveness at increasing contraceptive use and affecting related outcomes among couples. DISCUSSION Filling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel, multi-level, community-based intervention to increase contraceptive use among couples with an unmet need for family planning in rural Uganda. We aim to use the findings of this pilot study to refine the trial procedures and intervention content for a future, larger cluster randomized controlled trial to establish the intervention's efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT04262882; registered on February 10, 2020.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
- United States Agency for International Development (USAID), Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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Sileo KM, Wanyenze RK, Anecho A, Luttinen R, Semei C, Mukasa B, Musoke W, Vermund SH, Dworkin SL, Dovidio JF, Taylor BS, Kershaw TS. Protocol for the pilot quasi-experimental controlled trial of a gender-responsive implementation strategy with providers to improve HIV outcomes in Uganda. Pilot Feasibility Stud 2022; 8:264. [PMID: 36564795 PMCID: PMC9783690 DOI: 10.1186/s40814-022-01202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) is the most effective clinical intervention for reducing morbidity and mortality among persons living with HIV. However, in Uganda, there are disparities between men and women in viral load suppression and related HIV care engagement outcomes, which suggests problems with the implementation of ART. Gender norms are a known driver of HIV disparities in sub-Saharan Africa, and patient-provider relationships are a key factor in HIV care engagement; therefore, the role of gender norms is important to consider in interventions to achieve the equitable provision of treatment and the quality of ART counseling. METHODS The overall research objective of this study is to pilot test an implementation strategy (i.e., methods to improve the implementation of an evidence-based intervention) to increase providers' capacity to provide gender-responsive treatment and counseling to men and women on HIV treatment in Uganda. Delivered to HIV providers, this group training adapts evidence-based strategies to reduce gender biases and increase skills to deliver gender-specific and transformative HIV counseling to patients. The implementation strategy will be piloted through a quasi-experimental controlled trial. Clinics will be randomly assigned to either the intervention or control conditions. The trial will assess feasibility and acceptability and explore barriers and facilitators to implementation and future adoption while gathering preliminary evidence on the implementation strategy's effectiveness by comparing changes in patient (N = 240) and provider (N = 80-140) outcomes across intervention and control clinics through 12-month follow-up. Quantitative data will be descriptively analyzed, qualitative data will be analyzed through thematic analysis, and these data will be mixed during the presentation and interpretation of results where appropriate. DISCUSSION This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel implementation strategy to improve men and women's HIV care engagement, with the potential to reduce gender disparities in HIV outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT05178979 , retrospectively registered on January 5, 2022.
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Affiliation(s)
- K M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, USA.
| | - R K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - A Anecho
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - R Luttinen
- Department of Demography, The University of Texas at San Antonio, San Antonio, TX, USA
| | - C Semei
- Mildmay Uganda, Kampala, Uganda
| | | | | | - S H Vermund
- Yale School of Public Health, New Haven, CT, USA
| | - S L Dworkin
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA
| | - J F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - B S Taylor
- Division of Infectious Diseases, Department of Medicine, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - T S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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11
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Calabrese SK, Rao S, Eldahan AI, Tekeste M, Modrakovic D, Dangaran D, Boone CA, Underhill K, Krakower DS, Mayer KH, Hansen NB, Kershaw TS, Magnus M, Betancourt JR, Dovidio JF. "Let's Be a Person to Person and Have a Genuine Conversation": Comparing Perspectives on PrEP and Sexual Health Communication Between Black Sexual Minority Men and Healthcare Providers. Arch Sex Behav 2022; 51:2583-2601. [PMID: 35790614 PMCID: PMC10040304 DOI: 10.1007/s10508-021-02213-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 06/11/2023]
Abstract
Patient-provider communication is a key factor affecting HIV pre-exposure prophylaxis (PrEP) awareness and access among Black sexual minority men (SMM). Optimizing patient-provider communication requires a deeper understanding of communication dynamics. In this study, we investigated the perspectives of both HIV-negative/status-unknown Black SMM and practicing community healthcare providers regarding patient-provider communication about PrEP and sexual health. We conducted eleven semi-structured qualitative focus groups (six with Black SMM; five with providers) in the Northeastern USA and thematically analyzed transcripts. A total of 36 Black SMM and 27 providers participated in the focus groups. Our analysis revealed points of alignment and divergence in the two groups' perspectives related to patient-provider communication. Points of alignment included: (1) the importance ascribed to maximizing patients' comfort and (2) belief in patients' right to non-discriminatory healthcare. Points of divergence included: (1) Black SMM's preference for sexual privacy versus providers' preference that patients share sexual information, (2) Black SMM's perception that providers have an ethical responsibility to initiate conversations about PrEP with patients versus providers' perception of such conversations as being optional, and (3) Black SMM's preference for personalized sexual health conversations versus providers' preference for standardized conversations. Findings underscore a need for providers to offer more patient-centered sexual healthcare to Black SMM, which should entail routinely presenting all prevention options available-including PrEP-and inviting open dialogue about sex, while also respecting patients' preferences for privacy about their sexuality. This approach could increase PrEP access and improve equity in the US healthcare system.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Adam I Eldahan
- Columbia School of Nursing, Columbia University, New York, NY, USA
| | - Mehrit Tekeste
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - D Dangaran
- Harvard Law School, Harvard University, Cambridge, MA, USA
| | - Cheriko A Boone
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Kristen Underhill
- Columbia Law School, Columbia University, New York, NY, USA
- Heilbrunn Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Douglas S Krakower
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Population Medicine, Harvard University, Boston, MA, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Global Health and Population, Harvard University, Boston, MA, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | | | - John F Dovidio
- Social and Behavioral Sciences Department, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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12
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Calabrese SK, Kalwicz DA, Modrakovic D, Earnshaw VA, Edelman EJ, Bunting SR, Del Río-González AM, Magnus M, Mayer KH, Hansen NB, Kershaw TS, Rosenberger JG, Krakower DS, Dovidio JF. An Experimental Study of the Effects of Patient Race, Sexual Orientation, and Injection Drug Use on Providers' PrEP-Related Clinical Judgments. AIDS Behav 2022; 26:1393-1421. [PMID: 34750695 PMCID: PMC9434708 DOI: 10.1007/s10461-021-03495-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/16/2023]
Abstract
Social biases may influence providers' judgments related to pre-exposure prophylaxis (PrEP) and patients' consequent PrEP access. US primary and HIV care providers (n = 370) completed an experimental survey. Each provider reviewed one fictitious medical record of a patient seeking PrEP. Records varied by patient race (Black or White) and risk behavior (man who has sex with men [MSM], has sex with women [MSW], or injects drugs [MID]). Providers reported clinical judgments and completed measures of prejudice. Minimal evidence of racially biased judgments emerged. Providers expressing low-to-moderate sexual prejudice judged the MSM as more likely than the MSW to adhere to PrEP, which was associated with greater PrEP prescribing intention; sexual prejudice was negatively associated with anticipated MSM adherence. Providers judged the MID to be at higher risk, less likely to adhere, less safety-conscious, and less responsible than both the MSM and MSW; adverse adherence and responsibility judgments were associated with lower prescribing intention.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - E Jennifer Edelman
- Department of General Internal Medicine, Yale University, New Haven, CT, USA
| | - Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Ana María Del Río-González
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Manya Magnus
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - John F Dovidio
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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13
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Mehra R, Alspaugh A, Franck LS, McLemore MR, Kershaw TS, Ickovics JR, Keene DE, Sewell AA. “Police shootings, now that seems to be the main issue” – Black pregnant women’s anticipation of police brutality towards their children. BMC Public Health 2022; 22:146. [PMID: 35057776 PMCID: PMC8781435 DOI: 10.1186/s12889-022-12557-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/05/2022] [Indexed: 01/14/2023] Open
Abstract
Background A disproportionate number of people who are killed by police each year are Black. While much attention rightly remains on victims of police brutality, there is a sparse literature on police brutality and perinatal health outcomes. We aimed to explore how Black pregnant women perceive police brutality affects them during pregnancy and might affect their children. Methods This qualitative study involved semi-structured interviews among 24 Black pregnant women in New Haven, Connecticut (January 2017 to August 2018). Interview questions explored neighborhood factors, safety, stressors during pregnancy, and anticipated stressors while parenting. Grounded theory informed the analysis. Results Participants, regardless of socioeconomic status, shared experiences with police and beliefs about anticipated police brutality, as summarized in the following themes: (1) experiences that lead to police distrust – “If this is the way that mommy’s treated [by police]”; (2) anticipating police brutality – “I’m always expecting that phone call”; (3) stress and fear during pregnancy – “It’s a boy, [I feel] absolutely petrified”; and (4) ‘the talk’ about avoiding police brutality – “How do you get prepared?” Even participants who reported positive experiences with police anticipated brutality towards their children. Conclusions Interactions between Black people and police on a personal, familial, community, and societal level influenced how Black pregnant women understand the potential for police brutality towards their children. Anticipated police brutality is a source of stress during pregnancy, which may adversely influence maternal and infant health outcomes. Police brutality must be addressed in all communities to prevent harming the health of birthing people and their children.
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14
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Willie TC, Sharpless L, Monger M, Kershaw TS, Mahoney WB, Stockman JK. Enhancing domestic violence advocates' ability to discuss HIV pre-exposure prophylaxis (PrEP): Feasibility and acceptability of an educational intervention. Womens Health (Lond) 2022; 18:17455065211070548. [PMID: 35001751 PMCID: PMC8744168 DOI: 10.1177/17455065211070548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Survivors of intimate partner violence are at elevated risk for HIV acquisition, yet there is limited research on the best strategies to optimize biomedical HIV prevention, such as pre-exposure prophylaxis among this population. Domestic violence agencies are critical collaborating partners and function as potential entry points into HIV prevention services for survivors; however, limited knowledge regarding HIV prevention has been an important barrier to advocate-led discussions. This study aimed to develop, implement, and evaluate an HIV prevention intervention for domestic violence advocates. SETTING A nonrandomized, group-based intervention with pre-intervention, immediate post-intervention, and 3-month post-intervention periods were conducted with multiple domestic violence agencies in Mississippi. METHODS Overall, 25 domestic violence advocates participated in the two-session intervention. Surveys were administered to assess pre-exposure prophylaxis knowledge, self-efficacy, subjective norms, and willingness to provide HIV prevention services to intimate partner violence survivors. Generalized estimating equations were conducted to assess change in behavioral outcomes over time. RESULTS Compared to pre-intervention, there were significant increases at immediate and 3-month post-intervention in advocates' intervention acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to provide HIV prevention information, discuss pre-exposure prophylaxis eligibility criteria, assist pre-exposure prophylaxis-engaged clients, and initiate pre-exposure prophylaxis counseling. CONCLUSION This group-based intervention enhanced domestic violence advocates' acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to offer HIV care information, discuss pre-exposure prophylaxis eligibility, assist pre-exposure prophylaxis-engaged survivors, and initiate pre-exposure prophylaxis counseling with intimate partner violence survivors. Efforts should focus on training domestic violence advocates in HIV prevention care for survivors and also include these agencies in collaborative strategies to reduce HIV incidence.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurel Sharpless
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Mauda Monger
- MLM Center for Health Education and
Equity Consulting Services, Jackson, MS, USA
| | - Trace S Kershaw
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Wendy B Mahoney
- Mississippi Coalition Against Domestic
Violence, Jackson, MS, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and
Global Public Health, Department of Medicine, University of California San Diego, La
Jolla, CA, USA
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15
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Rao S, Reed AE, Parchem B, Edelman EJ, Magnus M, Hansen NB, Kershaw TS, Earnshaw VA, Krakower DS, Dovidio JF, Mayer KH, Underhill K, Rosenberger JG, Ogburn DF, Betancourt JR, Calabrese SK. Optimizing Provider Preexposure Prophylaxis (PrEP) Training: A Cross-Sectional Analysis of Recommendations from Providers Across the PrEP Implementation Cascade. AIDS Behav 2022; 26:218-231. [PMID: 34287754 PMCID: PMC8294250 DOI: 10.1007/s10461-021-03375-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Expanding PrEP access necessitates training that supports healthcare providers’ progression along the PrEP implementation cascade, moving from PrEP awareness to prescription. We surveyed 359 USA providers about PrEP training content and format recommendations. We examined the association between cascade location and training recommendations. Most providers were aware of PrEP (100%), willing to prescribe PrEP (97.2%), had discussed PrEP with patients (92.2%), and had prescribed PrEP (79.9%). Latent class regression analysis revealed that cascade location was associated with training recommendations. Although all providers recommended PrEP-specific content (e.g., patient eligibility), providers who were located further along the cascade also recommended more comprehensive content, including sexual history-taking and sexual and gender minority competence training. Providers further along the cascade were also more likely to recommend interactive training formats (e.g., role-playing). These insights from providers furthest along the cascade indicate the importance of including comprehensive content and interactive formats in future PrEP training initiatives.
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Affiliation(s)
- Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA.
| | - Ashley E Reed
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - Benjamin Parchem
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington DC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | | | - Kenneth H Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Kristen Underhill
- Population and Family Health and Law, Columbia University, New York City, NY, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Hyattsville, MD, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
- Department of Prevention and Community Health, Milken School of Public Health, George Washington University, Washington, DC, USA
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16
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Sileo KM, Kershaw TS, Gilliam S, Taylor E, Kommajosula A, Callands TA. Trauma Exposure and Intimate Partner Violence Among Young Pregnant Women in Liberia. J Interpers Violence 2021; 36:10101-10127. [PMID: 31625468 PMCID: PMC7778451 DOI: 10.1177/0886260519881533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Intimate partner violence (IPV) is a global threat to women's health and may be elevated among those exposed to traumatic events in post-conflict settings, such as Liberia. The purpose of this study was to examine potential mediators between lifetime exposure to traumatic events (i.e., war-related trauma, community violence) with recent experiences of IPV among 183 young, pregnant women in Monrovia, Liberia. Hypothesized mediators included mental health (depression, posttraumatic stress symptoms), insecure attachment style (anxious and avoidant attachment), and attitudes indicative of norms of violence (attitudes justifying wife beating). We tested a parallel multiple mediation model using the PROCESS method with bias-corrected and accelerated bootstrapping to test confidence intervals (CI). Results show that 45% of the sample had experienced any physical, sexual, or emotional IPV in their lifetime, and 32% in the 2 months prior to the interview. Exposure to traumatic events was positively associated with recent IPV severity (β = .40, p < .01). Taken together, depression, anxious attachment style, and justification of wife beating significantly mediated the relationship between exposure to traumatic events and experience of IPV (β = .15, 95% CI = [0.03, 0.31]). Only anxious attachment style (β = .07, 95% CI = [0.03, 0.16]) and justification of wife beating (β = .05, 95% CI = [0.01, 0.16]) were identified as individual mediators. This study reinforces pregnancy as an important window for both violence and mental health screening and intervention for young Liberian women. Furthermore, it adds to our theoretical understanding of mechanisms in which long-term exposure to traumatic events may lead to elevated rates of IPV in Liberia, and points to the need for trauma-informed counseling and multilevel gender transformative public health approaches to address violence against women.
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Affiliation(s)
- Katelyn M. Sileo
- The University of Texas at San Antonio, USA
- The Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
| | - Trace S. Kershaw
- The Center for Interdisciplinary Research at Yale University, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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17
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Brault MA, Curry LA, Kershaw TS, Singh K, Vash-Margita A, Camenga DR. Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health-Perspectives to Build an Appointment Planning Tool. J Pediatr Adolesc Gynecol 2021; 34:725-731. [PMID: 33989800 PMCID: PMC10712738 DOI: 10.1016/j.jpag.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/02/2021] [Accepted: 04/25/2021] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVE Input from adolescents and healthcare providers is needed to develop electronic tools that can support patient-centered sexual and reproductive (SRH) care. This study explores facilitators and barriers to patient-centered communication in the context of developing an electronic appointment planning tool to promote SRH communication in clinic settings. DESIGN In-depth interviews were conducted to explore what constitutes adolescent-friendly SRH care and communication, as well as on the design of the appointment planning tool. Interviews were coded iteratively, and analyzed using the software Atlas.TI v8. SETTING An adolescent primary care clinic, and a pediatric and adolescent gynecology clinic. PARTICIPANTS Adolescent girls (N=32; ages 14-18) and providers who care for adolescent girls (N=10). MAIN OUTCOME MEASURES Thematic analyses explored facilitators/barriers to SRH communication and care and preferences for the tool. RESULTS Facilitators identified by adolescents and providers included: direct patient/provider communication; adolescent-driven decision-making regarding care and contraceptive choice; supplementing clinic visits with electronic resources; and holistic care addressing physical, mental, and social needs. Barriers identified by participants included: limited time for appointments; limited adolescent autonomy in appointments; and poor continuity of care when adolescents cannot see the same provider. Given the complexity of issues raised, adolescents and providers were interested in developing an appointment planning tool to guide communication during appointments, and contributed input on its design. The resulting Appointment Planning Tool app pilot is in progress. CONCLUSIONS Qualitative interviews with adolescents and providers offer critical insights for the development and implementation of mobile health (mHealth) tools that can foster patient-centered care.
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Affiliation(s)
- Marie A Brault
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA.
| | - Leslie A Curry
- Global Health Leadership Initiative, 100 Church Street South, Yale School of Public Health, New Haven, CT, 06519, USA; Department of Health Policy and Management, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Karen Singh
- Department of Social and Behavioral Sciences, 60 College Street, PO Box 208034, Yale School of Public Health, New Haven, CT, 06520-8034, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Farnham Memorial Building, Yale School of Medicine, New Haven, CT, 06520, USA
| | - Deepa R Camenga
- Department of Emergency Medicine, 464 Congress Avenue, Suite 260, Yale School of Medicine, New Haven, CT, 06519, USA
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18
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Willie TC, Alexander KA, Caplon A, Kershaw TS, Safon CB, Galvao RW, Kaplan C, Caldwell A, Calabrese SK. Birth Control Sabotage as a Correlate of Women's Sexual Health Risk: An Exploratory Study. Womens Health Issues 2021; 31:157-163. [PMID: 33218751 PMCID: PMC8005431 DOI: 10.1016/j.whi.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To explore associations between birth control sabotage, a form of reproductive coercion, and women's sexual risk among women attending family planning health centers. Data were collected from a 2017 cross-sectional online survey of 675 women who attended Connecticut Planned Parenthood centers. Participants reported birth control sabotage; sexual risk (i.e., inconsistent condom use during vaginal and anal sex in the past 6 months, lifetime sexually transmitted infection diagnosis, lifetime exchange sex [trading sex for money, drugs, or other goods], and multiple sexual partners in the past 6 months); and sociodemographics. Bivariate and multivariable logistic regression models were used to examine associations between birth control sabotage and women's sexual risk. RESULTS One in six women (16.4%; n = 111) reported experiencing birth control sabotage. Women who reported birth control sabotage had a greater odds of ever having an sexually transmitted infection (adjusted odds ratio, 2.18; 95% confidence interval, 1.31-3.60; p = .003), ever engaging in exchange sex (adjusted odds ratio, 2.77; 95% confidence interval, 1.17-6.53; p = .020), and having multiple sexual partners in the past 6 months (adjusted odds ratio, 1.96; 95% confidence interval, 1.21-3.18; p = .006). CONCLUSIONS Our findings demonstrate increased engagement in sexual risk taking among women who reported birth control sabotage compared with women did not.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Kamila A Alexander
- Department of Community Public Health Nursing, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Amy Caplon
- Division of Cancer Control and Populations Sciences, National Cancer Institute, Rockville, Maryland
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Cara B Safon
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Rachel W Galvao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, Connecticut
| | - Abigail Caldwell
- Planned Parenthood of Southern New England, New Haven, Connecticut
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
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Sileo KM, Kershaw TS. Dimensions of Masculine Norms, Depression, and Mental Health Service Utilization: Results From a Prospective Cohort Study Among Emerging Adult Men in the United States. Am J Mens Health 2021; 14:1557988320906980. [PMID: 32079448 PMCID: PMC7036518 DOI: 10.1177/1557988320906980] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The purpose of this study was to examine the role of multidimensional masculine
norms (“status,” “toughness,” “anti-femininity”) on depression and mental health
service utilization among emerging adult men in the Northeast United States.
This study examines substance use and hostility as secondary outcomes and
depression status as an effect moderator on the relationship between masculine
norms and mental health service utilization. This study used data from a
prospective cohort study that followed 18- to 25-year-old heterosexual men over
6 months. At baseline and 6 months, approximately 29% and 25% of the sample met
the criteria for depression. The results of multivariate linear and logistic
regression models found that greater endorsement of masculine status was
associated with less depressive symptoms at baseline and 6 months, masculine
toughness was associated with more substance use at baseline, and masculine
anti-femininity was associated with greater hostility at baseline and 6 months.
The multivariate Poisson model found that greater endorsement of status was
associated with greater mental health service utilization in the prior year,
especially for men not meeting the criteria for depression. In contrast, greater
endorsement of anti-femininity and toughness norms was associated with less
mental health service utilization; for men endorsing toughness norms, this
effect was greater for those who were depressed. This study sheds light on the
harmful and protective effects of masculine norms on depression, related mental
health outcomes, and mental health service utilization, with implications for
gender-tailored approaches to engage and retain young men in mental health
services.
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Affiliation(s)
- Katelyn M Sileo
- The University of Texas at San Antonio, TX, USA.,The Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Trace S Kershaw
- The Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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20
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Mehra R, Boyd LM, Magriples U, Kershaw TS, Ickovics JR, Keene DE. Black Pregnant Women "Get the Most Judgment": A Qualitative Study of the Experiences of Black Women at the Intersection of Race, Gender, and Pregnancy. Womens Health Issues 2020; 30:484-492. [PMID: 32900575 PMCID: PMC7704604 DOI: 10.1016/j.whi.2020.08.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pronounced racial disparities in maternal and infant health outcomes persist in the United States. Using an ecosocial and intersectionality framework and biopsychosocial model of health, we aimed to understand Black pregnant women's experiences of gendered racism during pregnancy. METHODS We conducted semistructured interviews with 24 Black pregnant women in New Haven, Connecticut. We asked women about their experience of being pregnant, experiences of gendered racism, and concerns related to pregnancy and parenting Black children. Transcripts were coded by three trained analysts using grounded theory techniques. RESULTS Women experienced gendered racism during pregnancy-racialized pregnancy stigma-in the form of stereotypes stigmatizing Black motherhood that devalued Black pregnancies. Women reported encountering assumptions that they had low incomes, were single, and had multiple children, regardless of socioeconomic status, marital status, or parity. Women encountered racialized pregnancy stigma in everyday, health care, social services, and housing-related contexts, making it difficult to complete tasks without scrutiny. For many, racialized pregnancy stigma was a source of stress. To counteract these stereotypes, women used a variety of coping responses, including positive self-definition. CONCLUSIONS Racialized pregnancy stigma may contribute to poorer maternal and infant outcomes by way of reduced access to quality health care; impediments to services, resources, and social support; and poorer psychological health. Interventions to address racialized pregnancy stigma and its adverse consequences include anti-bias training for health care and social service providers; screening for racialized pregnancy stigma and providing evidence-based coping strategies; creating pregnancy support groups; and developing a broader societal discourse that values Black women and their pregnancies.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
| | - Lisa M Boyd
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Urania Magriples
- Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut; Yale-NUS College, Singapore
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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21
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Affiliation(s)
- Ijeoma Opara
- School of Social Welfare, Stony Brook University, 101 Nicolls Road, Health Sciences Center, Stony Brook, NY, 11794-8231, USA.
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA.
| | - Cristian J Chandler
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA
| | - Danielle C Alcena-Stiner
- School of Nursing, University of Rochester Medical Center, 601 Elmwood Avenue, Box SON, Rochester, NY, 14642, USA
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA
| | - Nkiru A Nnawulezi
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, Room 415, 60 College Street, New Haven, CT, 06520, USA
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA
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22
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Duffany KO, McVeigh KH, Lipkind HS, Kershaw TS, Ickovics JR. Large for Gestational Age and Risk for Academic Delays and Learning Disabilities: Assessing Modification by Maternal Obesity and Diabetes. Int J Environ Res Public Health 2020; 17:E5473. [PMID: 32751314 PMCID: PMC7432935 DOI: 10.3390/ijerph17155473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
The objective of this study was to examine academic delays for children born large for gestational age (LGA) and assess effect modification by maternal obesity and diabetes and then to characterize risks for LGA for those with a mediating condition. Cohort data were obtained from the New York City Longitudinal Study of Early Development, linking birth and educational records (n = 125,542). Logistic regression was used to compare children born LGA (>90th percentile) to those born appropriate weight (5-89th percentile) for risk of not meeting proficiency on assessments in the third grade and being referred to special education. Among children of women with gestational diabetes, children born LGA had an increased risk of underperforming in mathematics (ARR: 1.18 (95% CI: 1.07-1.31)) and for being referred for special education (ARR: 1.18 (95% CI: 1.02-1.37)). Children born LGA but of women who did not have gestational diabetes had a slightly decreased risk of academic underperformance (mathematics-ARR: 0.94 (95% CI: 0.90-0.97); Language arts-ARR: 0.96 (95% CI: 0.94-0.99)). Children born to women with gestational diabetes with an inadequate number of prenatal care visits were at increased risk of being born LGA, compared to those receiving extensive care (ARR: 1.67 (95% CI: 1.20-2.33)). Children born LGA of women with diabetes were at increased risk of delays; greater utilization of prenatal care among these diabetic women may decrease the incidence of LGA births.
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Affiliation(s)
- Kathleen O’Connor Duffany
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06410, USA; (T.S.K.); (J.R.I.)
| | - Katharine H. McVeigh
- Division of Family and Child Health, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA;
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Science, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06410, USA; (T.S.K.); (J.R.I.)
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06410, USA; (T.S.K.); (J.R.I.)
- Division of Social Sciences, Yale-NUS College, Singapore 138527, Singapore
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23
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Willie TC, Kershaw TS, Blackstock O, Galvao RW, Safon CB, Tekeste M, Ogburn DF, Wilbourn B, Modrakovic D, Taggart T, Kaplan C, Caldwell A, Calabrese SK. Racial and ethnic differences in women's HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemic. AIDS Care 2020; 33:219-228. [PMID: 32408837 DOI: 10.1080/09540121.2020.1762067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Women with syndemic conditions, i.e., two or more co-occurring epidemics, are at elevated risk for HIV acquisition and are therefore prime candidates for pre-exposure prophylaxis (PrEP). However, PrEP uptake remains low among women, especially among Black and Hispanic women. This study examined associations of syndemic conditions with PrEP attitudes and HIV risk among women, and the moderating effect of race and ethnicity. In 2017, 271 non-Hispanic Black, non-Hispanic White, and Hispanic, PrEP-eligible women engaged in care at Planned Parenthood in the northeastern region of the U.S. completed an online survey. Participants reported syndemic conditions (i.e., intimate partner violence, depression, substance use), PrEP attitudes (e.g., PrEP interest), HIV sexual risk (e.g., multiple male sexual partners), and sociodemographics. Structural equation modeling was used to examine the effects of syndemic conditions on PrEP attitudes and HIV risk, and the moderating effect of race and ethnicity. Women with more syndemic conditions had a higher odds of reporting multiple male sexual partners. Syndemic conditions were positively associated with PrEP attitudes for Hispanic women than non-Hispanic Black and White women. Women with syndemic conditions, particularly Hispanic women, may be receptive to interventions promoting PrEP.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Oni Blackstock
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Rachel W Galvao
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cara B Safon
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Health Law, Policy, and Management, Boston University, Boston, MA, USA
| | - Mehrit Tekeste
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brittany Wilbourn
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Tamara Taggart
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA.,Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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24
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Calabrese SK, Galvao RW, Dovidio JF, Willie TC, Safon CB, Kaplan C, Caldwell A, Blackstock O, Phillips NJ, Kershaw TS. Contraception as a Potential Gateway to Pre-Exposure Prophylaxis: US Women's Pre-Exposure Prophylaxis Modality Preferences Align with Their Birth Control Practices. AIDS Patient Care STDS 2020; 34:132-146. [PMID: 32202930 DOI: 10.1089/apc.2019.0242] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Addressing women's low uptake of HIV pre-exposure prophylaxis (PrEP) requires improved understanding of their product preferences. Such preferences should be contextualized according to other aspects of their reproductive health, including their contraception practices. We investigated women's preferences across 10 PrEP modalities currently available or under study and examined associations between PrEP modality preferences and contraception practices. Heterosexually active women recently engaged in care at Connecticut Planned Parenthood centers (n = 563) completed an online survey. Participants were presented with images and descriptions of 10 PrEP modalities and asked to indicate their preference and specify their reasoning in an open-response format. Participants also reported prior and current use of 16 contraception modalities along with relationship, sexual health, and sociodemographic characteristics. The sample included women ages 18-45 (45.3% 25 or younger) who were predominantly non-Hispanic black (35.7%) or white (33.7%). All PrEP modalities presented were preferred by at least some women, with daily pills (24.9%), injections (24.3%), and invisible implants (14.9%) preferred most commonly. Across all modalities, associated reasoning often centered around ease of use and comfort. Coincidence with contraception modality was the third-most common reason underlying women's preferences. Women currently using the analogous contraception modality versus never having used it had higher odds of preferring PrEP daily pills [adjusted odds ratio (AOR) = 2.03], injections (AOR = 8.45), invisible implants (AOR = 11.63), and vaginal rings (AOR = 8.66). Diversification of available PrEP modalities and prioritization of those coinciding with popular contraception practices-especially daily pills, injections, and implants-could optimize PrEP acceptability, encourage PrEP uptake, and ultimately reduce HIV incidence among women.
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Affiliation(s)
- Sarah K. Calabrese
- Department of Psychological and Brain Sciences and George Washington University, Washington, District of Columbia
- Department of Prevention and Community Health, George Washington University, Washington, District of Columbia
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Rachel W. Galvao
- Department of Psychological and Brain Sciences and George Washington University, Washington, District of Columbia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John F. Dovidio
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
- Social and Behavioral Sciences Department, Yale University, New Haven, Connecticut
| | - Tiara C. Willie
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cara B. Safon
- Social and Behavioral Sciences Department, Yale University, New Haven, Connecticut
- Department of Health Law, Policy, and Management, Boston University, Boston, Massachusetts
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, Connecticut
| | - Abigail Caldwell
- Planned Parenthood of Southern New England, New Haven, Connecticut
| | - Oni Blackstock
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Division of General Internal Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Trace S. Kershaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Social and Behavioral Sciences Department, Yale University, New Haven, Connecticut
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25
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Willie TC, Keene DE, Stockman JK, Alexander KA, Calabrese SK, Kershaw TS. Intimate Partner Violence Influences Women's Engagement in the Early Stages of the HIV Pre-exposure Prophylaxis (PrEP) Care Continuum: Using Doubly Robust Estimation. AIDS Behav 2020; 24:560-567. [PMID: 30915581 DOI: 10.1007/s10461-019-02469-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Intimate partner violence (IPV) is associated with pre-exposure prophylaxis (PrEP) acceptability among US women, but whether IPV influences other steps along the PrEP care continuum remains unclear. This study estimated the causal effects of IPV on the early stages of the PrEP care continuum using doubly robust (DR) estimation (statistical method allowing causal inference in non-randomized studies). Data were collected (2017-2018) from a cohort study of 124 US women without and 94 women with IPV experiences in the past 6 months (N = 218). Of the 218 women, 12.4% were worried about getting HIV, 22.9% knew of PrEP, 32.1% intended to use PrEP, and 40.4% preferred an "invisible" PrEP modality. IPV predicts HIV-related worry (DR estimate = 0.139, SE = 0.049, p = 0.004). IPV causes women to be more concerned about contracting HIV. Women experiencing IPV are worried about HIV, but this population may need trauma-informed approaches to help facilitate their PrEP interest and intentions.
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Affiliation(s)
- Tiara C Willie
- Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Danya E Keene
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kamila A Alexander
- Department of Community Public Health Nursing, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Rm 417, Baltimore, MD, 21205, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Trace S Kershaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, USA
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26
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Martinez I, Kershaw TS, Keene D, Perez-Escamilla R, Lewis JB, Tobin JN, Ickovics JR. Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City. Ann Behav Med 2019; 52:42-52. [PMID: 28707175 DOI: 10.1007/s12160-017-9924-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Syndemics are co-occurring epidemics that synergistically contribute to specific risks or health outcomes. Although there is substantial evidence demonstrating their existence, little is known about their change over time in adolescents. Purpose The objectives of this paper were to identify longitudinal changes in a syndemic of substance use, intimate partner violence, and depression and determine whether immigration/cultural factors moderate this syndemic over time. Methods In a cohort of 772 pregnant Latina adolescents (ages 14-21) in New York City, we examined substance use, intimate partner violence, and depression as a syndemic. We used longitudinal mixed-effect modeling to evaluate whether higher syndemic score predicted higher syndemic severity, from pregnancy through 1 year postpartum. Interaction terms were used to determine whether immigrant generation and separated orientation were significant moderators of change over time. Results We found a significant increasing linear effect for syndemic severity over time (β = 0.0413, P = 0.005). Syndemic score significantly predicted syndemic severity (β = -0.1390, P ≤ 0.0001), as did immigrant generation (βImmigrant = -0.1348, P ≤ 0.0001; β1stGen = -0.1932, P = 0.0005). Both immigrant generation (βImmigrant = -0.1125, P = 0.0035; β1stGen = -0.0135, P = 0.7279) and separated orientation (β = 0.0946, P = 0.0299) were significantly associated with change in severity from pregnancy to 1 year postpartum. Conclusion Pregnancy provides an opportunity for reducing syndemic risk among Latina adolescents. Future research should explore syndemic changes over time, particularly among high-risk adolescents. Prevention should target syndemic risk reduction in the postpartum period to ensure that risk factors do not increase after pregnancy.
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Affiliation(s)
- Isabel Martinez
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Danya Keene
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Rafael Perez-Escamilla
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
| | | | - Jeannette R Ickovics
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
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27
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Sileo KM, Kershaw TS, Callands TA. A syndemic of psychosocial and mental health problems in Liberia: Examining the link to transactional sex among young pregnant women. Glob Public Health 2019; 14:1442-1453. [PMID: 31010396 PMCID: PMC6938027 DOI: 10.1080/17441692.2019.1607523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/01/2019] [Indexed: 01/12/2023]
Abstract
Transactional sex may be a driver of the rising HIV epidemic in Liberia, especially among young women. The goal of this study was to explore the independent and additive effects of psychosocial conditions on engagement in transactional sex among 191 pregnant women in Monrovia, Liberia. Between March and August 2016, women receiving prenatal services completed a cross-sectional structured questionnaire. These data were used to examine the independent and additive effects of exposure to trauma, depression, post-traumatic stress disorder symptoms, and intimate partner violence on transactional sex. Overall, the results are in support of our hypothesis that these psychosocial conditions cluster together and are independently associated with transactional sex. Multivariate logistic regression analysis demonstrated an additive effect of the number of psychosocial conditions experienced on transactional sex. Women experiencing 2 psychosocial conditions had 5.96 greater odds of engaging in transactional sex compared to women reporting 0 conditions (AOR: 5.96, 95% CI: 2.22-15.99), and women experiencing 3 or 4 psychosocial conditions had 11.91 greater odds of engaging in transactional sex compared to women report 0 conditions (AOR: 11.91, 95% CI: 4.12-34.45). Our results demonstrate the need for comprehensive HIV prevention programming inclusive of mental health support and IPV prevention for Liberian women.
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Affiliation(s)
- Katelyn M. Sileo
- The Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Trace S. Kershaw
- The Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Tamora A. Callands
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
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28
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Calabrese SK, Krakower DS, Willie TC, Kershaw TS, Mayer KH. US Guideline Criteria for Human Immunodeficiency Virus Preexposure Prophylaxis: Clinical Considerations and Caveats. Clin Infect Dis 2019; 69:884-889. [PMID: 30689766 PMCID: PMC7320075 DOI: 10.1093/cid/ciz046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/14/2019] [Indexed: 12/20/2022] Open
Abstract
Clinical guidelines for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) developed by the US Centers for Disease Control and Prevention have been instrumental in the implementation of PrEP in medical practices throughout the country. However, the eligibility criteria contained within may inadvertently limit PrEP access for some patients. We describe the following key considerations and caveats related to these criteria: promotion of a selective vs universal approach to sexual health education involving PrEP; misalignment between criteria stated in the table and text boxes; problematic categorization and confounding of sexual orientation, gender identity, and risk behavior; underemphasis of network/community-level drivers of HIV transmission; oversimplification of serodiscordant risk; and lack of clarity surrounding the relevance of condoms to PrEP eligibility. We offer concrete recommendations to address the identified issues and strengthen future iterations of the guidelines, applying these recommendations in an alternative table of "criteria."
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychology, George Washington University, Washington, DC
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University
- The Fenway Institute, Fenway Health
- Department of Population Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Tiara C Willie
- Miriam Hospital
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Trace S Kershaw
- Social and Behavioral Sciences Department, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University
- The Fenway Institute, Fenway Health
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
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29
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Mehra R, Keene DE, Kershaw TS, Ickovics JR, Warren JL. Racial and ethnic disparities in adverse birth outcomes: Differences by racial residential segregation. SSM Popul Health 2019; 8:100417. [PMID: 31193960 PMCID: PMC6545386 DOI: 10.1016/j.ssmph.2019.100417] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022] Open
Abstract
Racial and ethnic disparities in adverse birth outcomes have persistently been wide and may be explained by individual and area-level factors. Our primary objective was to determine if county-level black-white segregation modified the association between maternal race/ethnicity and adverse birth outcomes using birth records from the National Center for Health Statistics (2012). Based on maternal residence at birth, county-level black-white racial residential segregation was calculated along five dimensions of segregation: evenness, exposure, concentration, centralization, and clustering. We conducted a two-stage analysis: (1) county-specific logistic regression to determine whether maternal race and ethnicity were associated with preterm birth and term low birth weight; and (2) Bayesian meta-analyses to determine if segregation moderated these associations. We found greater black-white and Hispanic-white disparities in preterm birth in racially isolated counties (exposure) relative to non-isolated counties. We found reduced Hispanic-white disparities in term low birth weight in racially concentrated and centralized counties relative to non-segregated counties. Area-level poverty explained most of the moderating effect of segregation on disparities in adverse birth outcomes, suggesting that area-level poverty is a mediator of these associations. Segregation appears to modify racial/ethnic disparities in adverse birth outcomes. Therefore, policy interventions that reduce black-white racial isolation, or buffer the poor social and economic correlates of segregation, may help to reduce disparities in preterm birth and term low birth weight.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Danya E. Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT, 06510, United States
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Tekeste M, Hull S, Dovidio JF, Safon CB, Blackstock O, Taggart T, Kershaw TS, Kaplan C, Caldwell A, Lane SB, Calabrese SK. Differences in Medical Mistrust Between Black and White Women: Implications for Patient-Provider Communication About PrEP. AIDS Behav 2019; 23:1737-1748. [PMID: 30264207 DOI: 10.1007/s10461-018-2283-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention method. PrEP uptake has been persistently low among US women, particularly Black women, who account for 61% of new HIV diagnoses among women. Further understanding of barriers to Black women accessing PrEP is needed. This 2017 cross-sectional survey study explored race-based differences in PrEP interest and intention among women and the indirect association between race and comfort discussing PrEP with a healthcare provider through medical mistrust. The sample consisted of 501 adult women (241 Black; 260 White) who were HIV-negative, PrEP-inexperienced, and heterosexually active. Black women reported greater PrEP interest and intention than White women. However, Black women expressed higher levels of medical mistrust, which, in turn, was associated with lower comfort discussing PrEP with a provider. Medical mistrust may operate as a unique barrier to PrEP access among Black women who are interested in and could benefit from PrEP.
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Affiliation(s)
- Mehrit Tekeste
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
| | - Shawnika Hull
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Cara B Safon
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Oni Blackstock
- New York City Department of Health & Mental Hygiene, New York, NY, USA
| | - Tamara Taggart
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Trace S Kershaw
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Clair Kaplan
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | | | - Susan B Lane
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | - Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
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Abstract
Syndemic theory could explain the elevated HIV risk among transgender women (TGW) in India. Using cross-sectional data of 300 TGW in India, we aimed to: identify latent classes of four syndemic conditions (Depression-D, Alcohol use-A, Violence victimization-V, HIV-positive status), test whether syndemic classes mediate the association between stigma and sexual risk, and test whether social support and resilient coping moderate the association between syndemic classes and sexual risk. Four distinct classes emerged: (1) DAV Syndemic, (2) AV Syndemic, (3) DV Syndemic, and (4) No Syndemic. TGW in the DAV Syndemic (OR 9.80, 95% CI 3.45, 27.85, p < 0.001) and AV Syndemic classes (OR 2.74, 95% CI 1.19, 6.32, p < 0.01) had higher odds of inconsistent condom use in the past month than the No Syndemic class. Social support significantly moderated the effect of DAV Syndemic class on inconsistent condom use. DAV Syndemic was found to be a significant mediator of the effect of transgender identity stigma on sexual risk. HIV prevention programs among TGW need to: (a) incorporate multi-level multi-component interventions to address syndemic conditions, tailored to the nature of syndemic classes; (b) reduce societal stigma against TGW; and (c) improve social support to buffer the impact of syndemics on sexual risk.
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Hughto JMW, Reisner SL, Kershaw TS, Altice FL, Biello KB, Mimiaga MJ, Garofalo R, Kuhns LM, Pachankis JE. A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health (Oxf) 2019; 41:100-109. [PMID: 29474682 PMCID: PMC6490767 DOI: 10.1093/pubmed/fdy031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/04/2018] [Accepted: 01/31/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Transgender women are disproportionately incarcerated in the US relative to the general population. A dearth of research has explored the factors that predict incarceration among transgender women or the longitudinal impact of incarceration on the health of this population. METHODS Between 2012 and 2015, 221 transgender women ages 16-29 from Boston, MA and Chicago, IL were prospectively assessed at baseline, 4, 8 and 12 months. Mixed effects models were used to identify risk factors for incarceration and examine whether incarceration predicts somatic, anxiety and depressive symptoms, illicit drug use, and binge drinking over time, controlling for baseline psychiatric and substance use disorders. RESULTS Overall, 38% experienced incarceration, before (33%) and during (18%) the study period. Significant independent predictors of recent incarceration included sex work, recent homelessness, school dropout and number of times incarcerated prior to enrollment while recent incarceration significantly predicted somatic symptoms and illicit drug use over time. CONCLUSIONS Incarceration burden is high in young transgender women. Both structural and individual risk factors predict incarceration and poor health, suggesting the need for multilevel interventions to prevent incarceration and support young transgender women during incarceration and upon release.
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Affiliation(s)
- Jaclyn M White Hughto
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of General Pediatrics, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
- Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Trace S Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Fredrick L Altice
- Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Katie B Biello
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Matthew J Mimiaga
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry & Human Behavior, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Pediatrics and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John E Pachankis
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Calabrese SK, Tekeste M, Mayer KH, Magnus M, Krakower DS, Kershaw TS, Eldahan AI, Gaston Hawkins LA, Underhill K, Hansen NB, Betancourt JR, Dovidio JF. Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers. AIDS Patient Care STDS 2019; 33:79-88. [PMID: 30715918 DOI: 10.1089/apc.2018.0166] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Efforts to identify and address social inequities in HIV pre-exposure prophylaxis (PrEP) access are urgently needed. We investigated early-adopting PrEP prescribers' beliefs about how stigma contributes to PrEP access disparities in health care and explored potential intervention strategies within the context of PrEP service delivery. US-based PrEP prescribers were recruited through professional networks and participant referrals. Qualitative interviews were conducted, transcribed, and thematically analyzed. Participants (n = 18) were primarily male (72%); white (39%) or Asian (33%); and heterosexual (56%). Most practiced in the Northeastern (67%) or Southern (22%) United States; were physicians (94%); and specialized in HIV/infectious disease (89%). Participants described multiple forms of structural and interpersonal stigma impeding PrEP access. The requirement that PrEP be prescribed was a perceived deterrent for populations with medical mistrust and/or low health literacy. Practice norms such as discussing PrEP only in response to patient requests were seen as favoring more privileged groups. When probed about personally held biases, age-related stereotypes were the most readily acknowledged, including assumptions about older adults being sexually inactive and uncomfortable discussing sex. Participants criticized providers who chose not to prescribe PrEP within their clinical practice, particularly those whose decision reflected personal values related to condomless sex or discomfort communicating about sex with their patients. Suggested solutions included standardizing PrEP service delivery across patients and increasing cultural competence training. These early insights from a select sample of early-adopting providers illuminate mechanisms through which stigma could compromise PrEP access for key populations and corresponding points of intervention within the health care system.
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Affiliation(s)
- Sarah K. Calabrese
- Department of Psychology, George Washington University, Washington, District of Columbia
| | - Mehrit Tekeste
- Department of Psychology, George Washington University, Washington, District of Columbia
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Trace S. Kershaw
- Social and Behavioral Sciences Department, Yale School of Public Health, Yale University, New Haven, Connecticut
| | | | | | - Kristen Underhill
- Columbia Law School, Columbia University, New York, New York
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Nathan B. Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Joseph R. Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - John F. Dovidio
- Department of Psychology, Yale University, New Haven, Connecticut
- Chronic Disease Epidemiology Department, Yale School of Public Health, Yale University, New Haven, Connecticut
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Willie TC, Kershaw TS. An ecological analysis of gender inequality and intimate partner violence in the United States. Prev Med 2019; 118:257-263. [PMID: 30393017 PMCID: PMC6322926 DOI: 10.1016/j.ypmed.2018.10.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 11/16/2022]
Abstract
The purpose of this research was to assess the association between Gender Inequality Index and prevalence of lifetime intimate partner violence (IPV) among women and men at the state-level. Recently developed 2017 state-level prevalence estimates of IPV among a nationally-representative sample of U.S. non-institutionalized adults between 2010 and 2012 from the National Intimate Partner and Sexual Violence Survey was combined with calculated indexes for state-level gender inequality. Gender Inequality Index, created by the United Nations, reflects gender-based disadvantage in reproductive health, empowerment, and labor market participation. Correlations and linear regressions were used to examine associations between gender inequality and IPV. Gender Inequality Index values ranged from 0.149 to 0.381. The lifetime prevalence of IPV ranged between 27.8% and 45.3% for women and between 18.5% and 38.6% for men. Across states, the Gender Inequality Index was positively correlated with the prevalence of any form of IPV (r = 0.28, p < .05) and psychological IPV among women (r = 0.41, p < .01). The adjusted regression model showed a positive association between gender inequality and psychological IPV among women (B = 1.61, SE = 0.57, p = .007). Structural changes to gender inequality may help to reduce occurrences of IPV and improve the wellbeing and livelihood of women and girls.
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Affiliation(s)
- Tiara C Willie
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Trace S Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, T32 Training, Center for Interdisciplinary Research on AIDS, New Haven, CT, USA
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Willie T, Kershaw TS. Associations Between Latent Classes of Interpersonal Polyvictimization and Polyperpetration and Sexual Risk Behaviors Among Young Pregnant Couples: A Dyadic Analysis. Arch Sex Behav 2018; 47:1699-1709. [PMID: 29797147 PMCID: PMC6035097 DOI: 10.1007/s10508-018-1183-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Abstract
Interpersonal violence victimization and perpetration have been associated with sexual risk behaviors among adolescents and young adults, but research is lacking on: (1) how patterns of interpersonal polyvictimization and polyperpetration are associated with sexual risk among young pregnant couples, and (2) how individual and partner experiences of violence differentially impact sexual risk. The current analyses used baseline data from a longitudinal study that followed 296 pregnant young couples from pregnancy to 12 months postpartum. Couples were recruited at obstetrics and gynecology clinics, and an ultrasound clinic in the U.S. Latent class analysis identified subgroups based on polyvictimization and polyperpetration. Using the Actor-Partner Interdependence Model, path analyses assessed actor-partner effects of class membership on sexual risk. Three latent classes were used for women: Class 1: Polyvictim-Polyperpetrator; Class 2: Nonvictim-Nonperpetrator; and Class 3: Community and Prior IPV Victim. Four latent classes were used for men: Class 1: Community and Prior IPV Victim; Class 2: Polyvictim-Nonpartner Perpetrator; Class 3: Prior IPV and Peer Victim; and Class 4: Nonvictim-Nonperpetrator. Path analyses revealed that females in Class 2 and their male partners had higher condom use than females in Class 3. Males in Class 2 had more sexual partners than males in Class 1. Among nonmonogamous couples, males in Class 2 were less likely to be involved with a female partner reporting unprotected sex than males in Class 1. Among nonmonogamous couples, females in Class 2 had more acts of unprotected sex than females in Class 1. Males in Class 4 were less likely to have concurrent sexual partners compared to males in Class 1. Risk reduction interventions should address both victimization and perpetration. Additional research is needed to understand how mechanisms driving differential sexual risk by patterns of interpersonal polyvictimization and polyperpetration.
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Affiliation(s)
- Tiara Willie
- Yale School of Public Health, Yale University, New Haven, CT, 06520, USA.
| | - Trace S Kershaw
- Yale School of Public Health, Yale University, New Haven, CT, 06520, USA
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Willie TC, Stockman JK, Perler R, Kershaw TS. Associations between intimate partner violence, violence-related policies, and HIV diagnosis rate among women in the United States. Ann Epidemiol 2018; 28:881-885. [PMID: 30055935 DOI: 10.1016/j.annepidem.2018.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/25/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the association between state-level intimate partner violence (IPV) prevalence and HIV diagnosis rates among women in the United States and investigate the modifying effect of state IPV health care policies. METHODS Data on HIV diagnosis rates were collected from HIV surveillance data from 2010 to 2015, and IPV prevalence data were collected from the National Intimate Partner and Sexual Violence Survey from 2010 to 2012. States were coded for IPV health care policies on training, screening, reporting, and insurance discrimination. RESULTS States with higher IPV prevalence was associated with higher HIV diagnoses among women (B = 0.02; 95% confidence interval [CI] = 0.003, 0.04; P = .02). State policies were a significant effect modifier (B = -0.05; 95% CI = -0.07, -0.02; P < .001). Simple slopes revealed that the association between IPV and HIV diagnosis rates was stronger in states with low IPV protective health care policies (B = 0.09; CI = 0.06, 0.13; P < .001) and moderate IPV protective policies (B = 0.05; 95% CI = 0.02, 0.07, P < .001), but not in states with high IPV protective policies (B = -0.009; 95% CI = -0.04, 0.02; P = .59). CONCLUSIONS HIV prevention programs should target IPV and link to community resources. IPV-related policies in the health care system may protect the sexual health of women experiencing IPV.
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Affiliation(s)
- Tiara C Willie
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine and Director of the Disparities Core of the UCSD Center for AIDS Research, La Jolla, CA
| | | | - Trace S Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, and Director of T32 Training, Center for Interdisciplinary Research on AIDS, New Haven, CT
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White Hughto JM, Clark KA, Altice FL, Reisner SL, Kershaw TS, Pachankis JE. Creating, reinforcing, and resisting the gender binary: a qualitative study of transgender women's healthcare experiences in sex-segregated jails and prisons. Int J Prison Health 2018; 14:69-88. [PMID: 29869582 PMCID: PMC5992494 DOI: 10.1108/ijph-02-2017-0011] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues. Design/methodology/approach In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated. Findings Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers' transgender bias, others attributed barriers to providers' limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants' health while incarcerated. Research limitations/implications Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women's access to quality, gender-affirmative healthcare. Originality/value This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women's acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.
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Affiliation(s)
- Jaclyn M White Hughto
- Departments of Epidemiology and Behavioral and Social Sciences at the Brown University School of Public Health , Providence, Rhode Island, USA
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Kirsty A Clark
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles , Los Angeles, California, USA
| | - Frederick L Altice
- Department of Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, Yale University , New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University , New Haven, Connecticut, USA
| | - Sari L Reisner
- Department of Epidemiology, Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Division of Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University , New Haven, Connecticut, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University , New Haven, Connecticut, USA
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Calabrese SK, Earnshaw VA, Underhill K, Krakower DS, Magnus M, Hansen NB, Mayer KH, Betancourt JR, Kershaw TS, Dovidio JF. Prevention paradox: Medical students are less inclined to prescribe HIV pre-exposure prophylaxis for patients in highest need. J Int AIDS Soc 2018; 21:e25147. [PMID: 29939488 PMCID: PMC6016621 DOI: 10.1002/jia2.25147] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/22/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite healthcare providers' growing awareness of pre-exposure prophylaxis (PrEP), prescription rates remain low. PrEP is an efficacious HIV prevention strategy recommended for use with condoms but still protective in their absence. Concern about the impact of PrEP on condom use and other risk behaviour is, nonetheless, among the barriers to prescription commonly reported. To understand the implications of this concern for PrEP access, we examined how medical students' willingness to prescribe PrEP varied by patients' condom use and partnering practices. We also assessed the perceived acceptability of various reasons for condom discontinuation with PrEP. METHODS An online survey was distributed to 854 medical students in the Northeastern US in 2015. Participants (n = 111) were surveyed about their willingness to prescribe PrEP for each of six male patients who systematically differed in their reported condom use (sustained use, sustained nonuse, or discontinuation with PrEP) and partnering practices (single male partner with untreated HIV or multiple male partners of unknown HIV status). Participants also reported perceived acceptability of four reasons for condom discontinuation: pleasure, sexual functioning, intimacy, and conception. RESULTS Willingness to prescribe PrEP was inconsistent with patient risk: When the patient used condoms and planned to sustain condom use, most participants were willing to prescribe PrEP - 93% if the patient had a single partner and 86% if the patient had multiple partners. Fewer were willing to prescribe if the patient did not use condoms and planned to sustain nonuse (53% and 45%, respectively) or used condoms but planned to discontinue use (27% and 28%). Significantly fewer participants were willing to prescribe for a patient with multiple partners versus a single partner when the patient reported sustained condom use or sustained condom nonuse. The number of participants who were willing to prescribe was similarly low for a patient with multiple partners versus a single partner when the patient reported that he planned to discontinue condom use. More participants accepted a patient discontinuing condoms for conception (69%) than for intimacy (23%), pleasure (14%), or sexual functioning (13%). CONCLUSION Medical students' clinical judgments were misaligned with patient risk and suggest misconceptions or personal values may undermine provision of optimal HIV prevention services.
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Affiliation(s)
- Sarah K Calabrese
- Department of PsychologyGeorge Washington UniversityWashingtonDCUSA
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
| | - Valerie A Earnshaw
- Department of Human Development and Family StudiesUniversity of DelawareNewarkDEUSA
| | - Kristen Underhill
- Columbia Law SchoolColumbia UniversityNew YorkNYUSA
- Heilbrunn Department of Population & Family HealthMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Douglas S Krakower
- The Fenway InstituteFenway HealthBostonMAUSA
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard UniversityBostonMAUSA
- Department of Population MedicineHarvard Medical SchoolHarvard UniversityBostonMAUSA
| | - Manya Magnus
- Department of Epidemiology and BiostatisticsMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Nathan B Hansen
- Department of Health Promotion and BehaviorCollege of Public HealthUniversity of GeorgiaAthensGAUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard UniversityBostonMAUSA
- Department of Global Health and PopulationHarvard TH Chan School of Public HealthHarvard UniversityBostonMAUSA
| | - Joseph R Betancourt
- Disparities Solutions CenterMassachusetts General HospitalHarvard Medical SchoolHarvard UniversityBostonMAUSA
| | - Trace S Kershaw
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
| | - John F Dovidio
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
- Department of PsychologyYale UniversityNew HavenCTUSA
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Willie TC, Kershaw TS, Callands TA. Examining relationships of intimate partner violence and food insecurity with HIV-related risk factors among young pregnant Liberian women. AIDS Care 2018; 30:1156-1160. [PMID: 29682990 DOI: 10.1080/09540121.2018.1466983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Gender inequities place women at an increased risk for HIV acquisition, and this association may particularly disenfranchize young pregnant women. Intimate partner violence (IPV) and food insecurity may contribute to gender differences in power, thereby influencing HIV disparities between women and men. Factors influencing gender disparities in HIV are unique and country-specific within sub-Saharan Africa, yet these factors are understudied among women in Liberia. This paper sought to examine the unique contributions and intersections of intimate partner violence (IPV) and food insecurity with HIV-related risk factors among young pregnant women in Liberia. Between March 2016 and August 2016, cross-sectional data collected from 195 women aged 18-30, residing in Monrovia, Liberia who were receiving prenatal services were used to examine the independent and interaction effects of IPV and food insecurity on HIV-related risk factors (i.e., sexual partner concurrency, economically-motivated relationships). IPV (31.3%) and food insecurity (47.7%) were prevalent. Young women who experience IPV are more likely to report food insecurity (p < 0.05). Young women who experienced IPV and food insecurity were more likely to start a new relationship for economic support (ps < 0.05). Young women who experience IPV and food insecurity were more likely to report engaging in transactional sex (ps < 0.05). There were no significant interaction effects between IPV and food insecurity (ps > 0.05). IPV and food insecurity each uniquely heighten young Liberian women's vulnerability to HIV. Intervention and policy efforts are need to promote and empower women's sexual health through integrated sexual and reproductive health services, and reduce IPV and food insecurity among pregnant Liberian women.
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Affiliation(s)
- Tiara C Willie
- a Department of Chronic Disease Epidemiology , Yale School of Public Health and the Center for Interdisciplinary Research on AIDS, Yale University , New Haven , CT , USA.,b Department of Health Promotion and Behavior , University of Georgia , Athens , GA , USA
| | - Trace S Kershaw
- c Department of Social and Behavioral Sciences , Yale School of Public Health and the Center for Interdisciplinary Research on AIDS, Yale University , New Haven , CT , USA
| | - Tamora A Callands
- b Department of Health Promotion and Behavior , University of Georgia , Athens , GA , USA
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Montanaro EA, Kershaw TS, Bryan AD. Dismantling the theory of planned behavior: evaluating the relative effectiveness of attempts to uniquely change attitudes, norms, and perceived behavioral control. J Behav Med 2018; 41:757-770. [PMID: 29671166 DOI: 10.1007/s10865-018-9923-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/07/2018] [Indexed: 11/24/2022]
Abstract
The current study compares the effectiveness of interventions that attempted to uniquely influence hypothesized determinants of behavior in the Theory of Planned Behavior versus some optimal combination of constructs (three constructs vs. four) to increase condom use among intentions and behavior college students. 317 participants (Mage = 19.31; SDage = 1.31; 53.3% female; 74.1% Caucasian) were randomly assigned to one of seven computer-based interventions. Interventions were designed using the Theory of Planned Behavior as the guiding theoretical framework. 196 (61.8%) completed behavioral follow-up assessments 3-month later. We found that the four construct intervention was marginally better at changing intentions (estimate = - .06, SE = .03, p = .06), but the single construct interventions were more strongly related to risky sexual behavior at follow-up (estimate = .04, SE = .02, p = .05). This study suggests that these constructs may work together synergistically to produce change (ClinicalTrials.gov Number NCT# 02855489).
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Affiliation(s)
- Erika A Montanaro
- Department of Psychology, University of North Carolina Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA.
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Willie TC, Stockman JK, Overstreet NM, Kershaw TS. Examining the Impact of Intimate Partner Violence Type and Timing on Pre-exposure Prophylaxis Awareness, Interest, and Coercion. AIDS Behav 2018; 22:1190-1200. [PMID: 28887703 DOI: 10.1007/s10461-017-1901-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Previous research suggests that intimate partner violence (IPV) is associated with acceptability of and adherence to pre-exposure prophylaxis (PrEP). However, very few studies have examined whether the type (i.e., physical, sexual, and psychological IPV) and timing (i.e., lifetime, past-year) of IPV experiences differentially relate to PrEP awareness, interest, and perceived PrEP coercion. Therefore, the objective of this study is to examine associations between lifetime and past-year physical, sexual, and psychological IPV experiences on PrEP awareness, interest, and perceived PrEP coercion. Data were collected from an online survey administered to 210 women and men. Past-year physical IPV experiences (AOR 4.53, 95% CI 1.85, 11.11) were significantly associated with being interested in using PrEP. Lifetime sexual (AOR 3.69, 95% CI 1.62, 8.40), psychological IPV (AOR 4.70, 95% CI 1.01, 21.89), and past-year sexual IPV experiences (AOR 3.01, 95% CI 1.10, 8.27) were also significantly associated with believing a recent partner would attempt to control the participant's use of PrEP, if she or he were currently using it. Understanding that engaging in PrEP care is influenced differently by the type and timing of IPV has potential implications for PrEP candidacy guidelines and interventions.
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Affiliation(s)
- Tiara C Willie
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA.
- Yale Center for Interdisciplinary Research on AIDS, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA.
| | - Jamila K Stockman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA
| | - Nicole M Overstreet
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA, 01610, USA
| | - Trace S Kershaw
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA
- Yale Center for Interdisciplinary Research on AIDS, 135 College Street, Suite 200, New Haven, CT, 06510-2483, USA
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Calabrese SK, Earnshaw VA, Krakower DS, Underhill K, Vincent W, Magnus M, Hansen NB, Kershaw TS, Mayer KH, Betancourt JR, Dovidio JF. A Closer Look at Racism and Heterosexism in Medical Students' Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education. AIDS Behav 2018; 22:1122-1138. [PMID: 29151200 PMCID: PMC5878986 DOI: 10.1007/s10461-017-1979-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Valerie A Earnshaw
- Department of Human Development and Family Studies, University of Delaware, Newark, DE, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Wilson Vincent
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John F Dovidio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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43
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Willie TC, Callands TA, Kershaw TS. Intimate Partner Violence, Sexual Autonomy and Postpartum STD Prevention Among Young Couples: A Mediation Analysis. Perspect Sex Reprod Health 2018; 50:25-32. [PMID: 29431903 PMCID: PMC5996382 DOI: 10.1363/psrh.12050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 06/08/2023]
Abstract
CONTEXT The transition to parenthood is a stressful time for young couples and can put them at risk for acquiring STDs. Mechanisms underlying this risk-particularly, intimate partner violence (IPV) and sexual autonomy-have not been well studied. METHODS Between 2007 and 2011, a prospective cohort study of the relationships and health of pregnant adolescents and their male partners recruited 296 couples at four hospital-based obstetrics and gynecology clinics in the U.S. Northeast; participants were followed up six and 12 months after the birth. Structural equation modeling identified associations among IPV at baseline and six months, sexual autonomy at six months and STD acquisition at 12 months. Mediating effects of sexual autonomy were tested via bootstrapping. RESULTS Females were aged 14-21, and male partners were 14 or older. For females, IPV victimization at baseline was positively associated with the likelihood of acquiring a postpartum STD (coefficient, 0.4); level of sexual autonomy was inversely associated with the likelihood of acquiring an STD and of having a male partner who acquired one by the 12-month follow-up (-0.4 for each). For males, IPV victimization at baseline was negatively correlated with a female partner's sexual autonomy (-0.3) and likelihood of acquiring an STD (-0.7); victimization at six months was positively related to a partner's sexual autonomy (0.2). Sexual autonomy did not mediate these relationships. CONCLUSIONS Females' sexual autonomy appears to protect against postpartum STDs for both partners. Future research should explore the efficacy of IPV-informed approaches to improving women's sexual and reproductive health.
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Affiliation(s)
- Tiara C Willie
- Department of Chronic Disease Epidemiology, Yale School of Public Health
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
| | - Tamora A Callands
- Department of Health Promotion and Behavior, University of Georgia, Athens
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health
- Interdisciplinary Research Methods Core, Center for Interdisciplinary Research on AIDS
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Earnshaw VA, Rosenthal L, Gilstad-Hayden K, Carroll-Scott A, Kershaw TS, Santilli A, Ickovics JR. Intersectional experiences of discrimination in a low-resource urban community: An exploratory latent class analysis. J Community Appl Soc Psychol 2018. [DOI: 10.1002/casp.2342] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Valerie A. Earnshaw
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Human Development and Family Sciences; University of Delaware; Newark DE USA
| | - Lisa Rosenthal
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Psychology; Pace University; New York City NY USA
| | - Kathryn Gilstad-Hayden
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
| | - Amy Carroll-Scott
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Community Health and Prevention; Drexel School of Public Health; Philadelphia PA USA
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences; Yale School of Public Health; New Haven CT USA
| | - Alycia Santilli
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- School of Health and Human Services; Southern Connecticut State University; New Haven CT USA
| | - Jeannette R. Ickovics
- Community Alliance for Research and Engagement; Yale School of Public Health; New Haven CT USA
- Department of Social and Behavioral Sciences; Yale School of Public Health; New Haven CT USA
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45
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Calabrese SK, Earnshaw VA, Magnus M, Hansen NB, Krakower DS, Underhill K, Mayer KH, Kershaw TS, Betancourt JR, Dovidio JF. Sexual Stereotypes Ascribed to Black Men Who Have Sex with Men: An Intersectional Analysis. Arch Sex Behav 2018; 47:143-156. [PMID: 28224313 PMCID: PMC5565715 DOI: 10.1007/s10508-016-0911-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/11/2016] [Accepted: 11/25/2016] [Indexed: 05/15/2023]
Abstract
Sexual stereotypes may adversely affect the health of Black men who have sex with men (MSM). Greater understanding of the nature and nuances of these stereotypes is needed. This online, survey-based study used an inductive, intersectional approach to characterize the sexual stereotypes ascribed to Black MSM by the U.S. general public, their distinctiveness from those ascribed to Black men and MSM in general, and their relative prototypicality as compared to dominant subgroups. Members of the public, recruited in 2014-2015, were randomly assigned to survey conditions that varied systematically by race (Black, White, or unspecified) and sexual orientation (gay, heterosexual, or unspecified) of a designated social group. Participants (n = 285) reported stereotypes of their assigned group that they perceived to exist in U.S. culture in an open-response format. Cross-condition comparisons revealed that, overall, Black gay male stereotypes were non-prototypical of Black men or gay men. Rather, stereotypes of Black men were more similar to Black heterosexual men and stereotypes of gay men were more similar to White gay men. Nonetheless, 11 of the 15 most frequently reported Black gay male stereotypes overlapped with stereotypes of Black men (e.g., large penis), gay men (e.g., deviant), or both (e.g., promiscuous). Four stereotypes were unique relative to both Black men and gay men: down low, diseased, loud, and dirty. Findings suggest that Black MSM face multiple derogatory sexual stereotypes, several of which are group-specific. These stereotypes are consistent with cultural (mis)representations of Black MSM and suggest a need for more accurate portrayals of existing sexual diversity within this group.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychology, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
| | - Valerie A Earnshaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Human Development and Family Studies, University of Delaware, Newark, DE, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | - Douglas S Krakower
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kristen Underhill
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Columbia Law School, New York, NY, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John F Dovidio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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46
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White Hughto JM, Clark KA, Altice FL, Reisner SL, Kershaw TS, Pachankis JE. Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention. Soc Sci Med 2017; 195:159-169. [PMID: 29096945 PMCID: PMC5712271 DOI: 10.1016/j.socscimed.2017.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/26/2022]
Abstract
RATIONALE Correctional healthcare providers' limited cultural and clinical competence to care for transgender patients represents a barrier to care for incarcerated transgender individuals. OBJECTIVE The present study aimed to adapt, deliver, and evaluate a transgender cultural and clinical competence intervention for correctional healthcare providers. METHOD In the summer of 2016, a theoretically-informed, group-based intervention to improve transgender cultural and clinical competence was delivered to 34 correctional healthcare providers in New England. A confidential survey assessed providers' cultural and clinical competence to care for transgender patients, self-efficacy to provide hormone therapy, subjective norms related to transgender care, and willingness to provide gender-affirming care to transgender patients before and after (immediately and 3-months) the intervention. Linear mixed effects regression models were fit to assess change in study outcomes over time. Qualitative exit interviews assessed feasibility and acceptability of the intervention. RESULTS Providers' willingness to provide gender-affirming care improved immediately post-intervention (β = 0.38; SE = 0.41, p < 0.001) and from baseline to 3-months post-intervention (β = 0.36; SE = 0.09; p < 0.001; omnibus test of fixed effects χ2 = 23.21; p < 0.001). On average, transgender cultural competence (χ2 = 22.49; p < 0.001), medical gender affirmation knowledge (χ2 = 11.24; p = 0.01), self-efficacy to initiate hormones for transgender women, and subjective norms related to transgender care (χ2 = 14.69; p = 0.001) all significantly increased over time. Providers found the intervention to be highly acceptable and recommended that the training be scaled-up to other correctional healthcare providers and expanded to custody staff. CONCLUSION The intervention increased correctional healthcare providers' cultural and clinical competence, self-efficacy, subjective norms, and willingness to provide gender-affirming care to transgender patients. Continued efforts should be made to train correctional healthcare providers in culturally and clinically competent gender-affirming care in order to improve the health of incarcerated transgender people. Future efficacy testing of this intervention is warranted.
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Affiliation(s)
- Jaclyn M White Hughto
- Yale School of Public Health, United States; The Fenway Institute, Fenway Health, United States.
| | - Kirsty A Clark
- University of California Los Angeles Fielding School of Public Health, United States
| | - Frederick L Altice
- Yale School of Public Health, United States; Yale School of Medicine, United States
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, United States; Boston Children's Hospital/Harvard Medical School, United States; Harvard T.H Chan School of Public Health, United States
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47
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Willie TC, Chakrapani V, White Hughto JM, Kershaw TS. Victimization and Human Immunodeficiency Virus-Related Risk Among Transgender Women in India: A Latent Profile Analysis. Violence Gend 2017; 4:121-129. [PMID: 29279854 PMCID: PMC5734163 DOI: 10.1089/vio.2017.0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Globally, transgender women (TGW) experience multiple forms of victimization such as violence and discrimination that can place them at risk for poor sexual health. To date, research overlooks the heterogeneity in experiences of victimization among TGW. Furthermore, few studies have examined the association between victimization and sexual risk among TGW in India, despite the high burden of HIV and victimization in this community. Latent profile analysis was performed to identify patterns of victimization in a convenience sample of 299 TGW recruited from nongovernmental organizations across four states in India. Analysis of covariance was performed to examine differences in sexual risk (i.e., alcohol use before sex; inconsistent condom use with a male regular partner, a male causal partner, and a male paying partner; and having multiple sexual partners) between latent profiles. Five distinct profiles of Indian TGW were identified based on the type and severity of victimization: (1) Low victimization, (2) High verbal police victimization, (3) High verbal and physical police victimization, (4) Moderate victimization, and (5) High victimization. While controlling for age, education, income, HIV status, and marital status, results revealed that TGW in the moderate victimization and high victimization profiles had higher sexual risk than TGW in the low victimization and high verbal police victimization profiles. In addition, TGW in high verbal and physical police victimization profile had higher sexual risk than TGW in low victimization profile. These findings underscore the importance of tailoring sexual risk reduction interventions to the specific needs of TGW based on patterns of victimization.
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Affiliation(s)
- Tiara C. Willie
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Venkatesan Chakrapani
- Postgraduate Institute of Medical Education and Research (PGIMER), School of Public Health, Chandigarh, India
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Jaclyn M. White Hughto
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Trace S. Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
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Calabrese SK, Magnus M, Mayer KH, Krakower DS, Eldahan AI, Hawkins LAG, Underhill K, Hansen NB, Kershaw TS, Betancourt JR, Dovidio JF. "Support Your Client at the Space That They're in": HIV Pre-Exposure Prophylaxis (PrEP) Prescribers' Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS 2017; 31:196-204. [PMID: 28414261 PMCID: PMC5404273 DOI: 10.1089/apc.2017.0002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Despite the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP) and evidence that most PrEP users do not engage in risk compensation (i.e., increased risk behavior due to a perceived decrease in HIV susceptibility), some healthcare providers report patient risk compensation to be a deterrent to prescribing PrEP. Overcoming this barrier is essential to supporting PrEP access and uptake among people at risk for HIV. To inform such efforts, this qualitative study explored PrEP-related risk compensation attitudes among providers with firsthand experience prescribing PrEP. US-based PrEP providers (n = 18), most of whom were HIV specialists, were recruited through direct outreach and referral from colleagues and other participants. Individual 90-min semistructured interviews were conducted by phone or in person from September 2014 through February 2015, transcribed, and thematically analyzed. Three attitudinal themes emerged: (1) providers' role is to support patients in making informed decisions, (2) risk behavior while taking PrEP does not fully offset PrEP's protective benefit (i.e., PrEP confers net protection, even with added behavioral risk), and (3) PrEP-related risk compensation is unduly stigmatized within and beyond the healthcare community. Participants were critical of other healthcare providers' negative judgment of patients and reluctance to prescribe PrEP due to anticipated risk compensation. Several providers also acknowledged an evolution in their thinking from initial ambivalence toward greater acceptance of PrEP and PrEP-related behavior change. PrEP providers' insights about risk compensation may help to address unsubstantiated concerns about PrEP-related risk compensation and challenge the acceptability of withholding PrEP on these grounds.
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Affiliation(s)
- Sarah K. Calabrese
- Department of Psychology, George Washington University, Washington, District of Columbia
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam I. Eldahan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Columbia School of Nursing, New York, New York
| | - Lauren A. Gaston Hawkins
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Kristen Underhill
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Yale Law School, New Haven, Connecticut
- Columbia Law School, New York, New York
| | - Nathan B. Hansen
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Trace S. Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Joseph R. Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John F. Dovidio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
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49
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Martinez I, Kershaw TS, Lewis JB, Stasko EC, Tobin JN, Ickovics JR. Between Synergy and Travesty: A Sexual Risk Syndemic Among Pregnant Latina Immigrant and Non-immigrant Adolescents. AIDS Behav 2017; 21:858-869. [PMID: 27338951 DOI: 10.1007/s10461-016-1461-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Substance use, intimate partner violence, and depression contribute to sexual risk individually, yet have not been evaluated as a syndemic for adolescents. Using data from 772 pregnant Latina adolescents, we evaluated these factors as a syndemic and tested the moderating role of immigration. Bivariate analyses showed syndemic score (OR = 1.40, p = 0.02) and severity (OR = 1.68, p = 0.006) were predictors for multiple sex partners, and syndemic score predicting STIs (OR = 1.15, p = 0.05). Syndemic severity remained significant in multivariate analyses for multiple sex partners (OR = 1.53, p = 0.04). Moderation analyses showed higher syndemic severity was associated with more condom use among immigrants (OR = 1.75, p = 0.04) and less condom use (OR = 0.07, p = 0.011) among those with separated orientation. Higher syndemic severity also predicted greater odds for multiple partners (OR = 2.40, p = 0.01) among immigrants. This evidence suggests a sexual risk syndemic exists among Latina adolescents. Research should continue exploring this phenomenon, particularly exploring the role immigration plays for sexual health.
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Affiliation(s)
- Isabel Martinez
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA.
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA
| | - Emily C Stasko
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Jeannette R Ickovics
- Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, 135 College St, Suite 200, New Haven, CT, 06510, USA
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50
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Peasant C, Montanaro EA, Kershaw TS, Parra GR, Weiss NH, Meyer JP, Murphy JG, Ritchwood TD, Sullivan TP. An event-level examination of successful condom negotiation strategies among young women. J Health Psychol 2017; 24:898-908. [PMID: 28810400 DOI: 10.1177/1359105317690598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examines the effect of condom negotiation strategies on condom use and partner type and substance use before sex as moderators of strategy effectiveness. Women reported their daily sexual behavior during the last month. Withholding sex was more strongly associated with condom use when utilized with a non-casual sex partner. Directly requesting condom use was more strongly and using deceptive reasons to influence condom use was less strongly related to condom use during substance use. Results underscore the importance of understanding the contexts in which condom negotiation strategies are successful in order to improve HIV/sexually transmitted infection prevention efforts among women.
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Affiliation(s)
| | - Erika A Montanaro
- 1 Yale University, USA.,3 The University of North Carolina at Charlotte, USA
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